Jezebel's Visit to the Oncologist

Just got back from the oncologist who seems to know her stuff. First off, she wanted the pathologist to take a second look at the lab report because the language the pathologist used was confusing and there was nothing about the margins included. At that time, the oncologist knew that they might not be able to get the margins due to the friable sample but she wanted that spelled out and included as an addendum to the report. She spoke to the pathologist who conceded that the language she used in the report was incorrect (she used the term transitional – type in a descriptive manner rather than as a term of art). The pathologist went back and looked at the report and clarified that there was definitely nasal cavity carcinoma (nose cavity that could potentially extend into the brain and involves the lining of the nasal cavity – more serious) rather than cancer of the planum (just the black part of the nose). Those are different types of cancer and, unfortunately, this was not good.

She examined Jezebel, did a full blood workup, took ex-rays of her heart and lungs (to check for metastasis) and also aspirated the lymph node to check for metastasis. The original emergency vet thought the lymph node was swollen but the oncologist didn’t think so (this was good). The good news was that her blood work was spectacular, she showed no signs of a tumor in the gross physical examination, her ex-rays and the lymph gland showed no signs of metastasis. The lab work did not show an aggressive tumor, rather, it was pronounced “low grade” and that is excellent. Other than this, she seems to be the picture of health. During this time, Jezebel had the good sense to hide behind the chair. She doesn't trust people in white coats wearing rubber gloves.
From there, we scheduled at CT scan for in the morning. The CT scan will see if there is a tumor in her muzzle and, if so, how far back it goes. At that point, the plan was that if the tumor was only on the tip of her nose, we probably wouldn’t do radiation – we’d just check it periodically. If the tumor extended beyond the nostril, she would probably have to have radiation. The CT scan would tell them how far back towards her brain the radiation would have to go. If the tumor goes a long way back (and it could) quality of life issues may make us decide to forgo treatment. If it only goes back a certain way, we will decide if that is what we will do. According to the vet, the CT scan will pretty much tell the tale EXCEPT if it looks like the tumor is only on the end of the nose, she’d want another pathologist to take a look at the original lab result. She also said that if it was her dog and the cancer was only at the nose tip, she’d skip the radiation and have periodic CT scans to see if it is on the move. I certainly hope this is the case but realize that nasal cavity cancer frequently fills up the whole area and the growth may have only been the tip of the ice burg.

I set up the CT scan for in the morning and was waiting to pay when the vet called us back in (the dogs were actually in the car with Husband and the vet called him on his cell). Seems the original pathologist got nervous about the questions being asked and went to take a re-look at Jezebel’s actual slide. Now, she isn’t sure – it might be a melanoma. She is going ahead and getting a second opinion and we should know in 24 – 48 hours what they come up with. My hope is that it is not that long. Melanoma is a bad, bad thing. The oncologist says that will probably amount to a bunch of pathologists in that lab all standing around looking at it and reaching a consensus. The oncologist says that melanoma typically is found in the mouth and not in this area. It is my hope that the pathologist is just freaked out at this point. She insisted, however, that whatever it is, it is definitely a tumor. I’m hoping her boss will look at it and pronounce that she is an idiot and it was only an expensive bee sting. I can dream, anyway.

The mean survival time for this sort of thing, with treatment, is 12 – 15 months (assuming it is a nasal carcinoma and not a melanoma). That is the mean, however. Jezebel is considerably younger than the mean age and in excellent health. It is frustrating not knowing what sort of cancer she has. We will hopefully know within a day or two the type of cancer and the extent it has invaded the nasal cavity. We won’t put her through hell but maybe we will get lucky. She is such a good girl.

So in the morning, we head off for the CT scan. If it looks like she is going to need radiation, they'll shave her muzzle so they know where to direct the radiation. The hair may never grow back or it might grow back a different color. She is such a pretty, pretty girl... Oh well. If it works, I'd be thrilled.

More as I learn more...